Healthcare Provider Details

I. General information

NPI: 1629679782
Provider Name (Legal Business Name): KRISTEN AILI JOHNSON PMHNP-BC, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/05/2020
Last Update Date: 04/13/2026
Certification Date: 04/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3674 S WASHINGTON ST
GRAND FORKS ND
58201
US

IV. Provider business mailing address

PO BOX 84101
SEATTLE WA
98124-5401
US

V. Phone/Fax

Practice location:
  • Phone: 701-205-3000
  • Fax:
Mailing address:
  • Phone: 907-335-7500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberR53273
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: